Factors That Influence Medical Student Selection of an Emergency Medicine Residency Program: Implications for Training Programs

Objectives:  An understanding of student decision‐making when selecting an emergency medicine (EM) training program is essential for program directors as they enter interview season. To build upon preexisting knowledge, a survey was created to identify and prioritize the factors influencing candidate decision‐making of U.S. medical graduates. Methods:  This was a cross‐sectional, multi‐institutional study that anonymously surveyed U.S. allopathic applicants to EM training programs. It took place in the 3‐week period between the 2011 National Residency Matching Program (NRMP) rank list submission deadline and the announcement of match results. Results:  Of 1,525 invitations to participate, 870 candidates (57%) completed the survey. Overall, 96% of respondents stated that both geographic location and individual program characteristics were important to decision‐making, with approximately equal numbers favoring location when compared to those who favored program characteristics. The most important factors in this regard were preference for a particular geographic location (74.9%, 95% confidence interval [CI] = 72% to 78%) and to be close to spouse, significant other, or family (59.7%, 95% CI = 56% to 63%). Factors pertaining to geographic location tend to be out of the control of the program leadership. The most important program factors include the interview experience (48.9%, 95% CI = 46% to 52%), personal experience with the residents (48.5%, 95% CI = 45% to 52%), and academic reputation (44.9%, 95% CI = 42% to 48%). Unlike location, individual program factors are often either directly or somewhat under the control of the program leadership. Several other factors were ranked as the most important factor a disproportionate number of times, including a rotation in that emergency department (ED), orientation (academic vs. community), and duration of training (3‐year vs. 4‐year programs). For a subset of applicants, these factors had particular importance in overall decision‐making. Conclusions:  The vast majority of applicants to EM residency programs employed a balance of geographic location factors with individual program factors in selecting a residency program. Specific program characteristics represent the greatest opportunity to maximize the success of the immediate interview experience/season, while others provide potential for strategic planning over time. A working knowledge of these results empowers program directors to make informed decisions while providing an appreciation for the limitations in attracting applicants.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91198/1/ACEM_1323_sm_DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/91198/2/j.1553-2712.2012.01323.x.pd

The AAMC Standardized Video Interview: Reactions and Use by Residency Programs During the 2018 Application Cycle

PURPOSE: To evaluate how emergency medicine (EM) residency programs perceived and used Association of American Medical Colleges (AAMC) SVI total scores and videos during the Electronic Residency Application Service (ERAS) 2018 cycle. METHOD: Study 1 (November 2017) used a program director survey to evaluate user reactions to the SVI following the first year of operational use. Study 2 (January 2018) analyzed program usage of SVI video responses using data collected through the AAMC Program Director\u27s Workstation. RESULTS: Results from the survey (125/175 programs, 71% response rate) and video usage analysis suggested programs viewed videos out of curiosity and to understand the range of SVI total scores. Programs were more likely to view videos for attendees of U.S. MD-granting medical schools and applicants with higher United States Medical Licensing Examination Step 1 scores, but there were no differences by gender or race/ethnicity. More than half of programs that did not use SVI total scores in their selection processes were unsure of how to incorporate them (36/58, 62%) and wanted additional research on utility (33/58, 57%). More than half of programs indicated being at least somewhat likely to use SVI total scores (55/97; 57%) and videos (52/99; 53%) in the future. CONCLUSIONS: Program reactions on the utility and ease of use of SVI total scores were mixed. Survey results indicate programs used the SVI cautiously in their selection processes, consistent with AAMC recommendations. Future surveys of SVI users will help the AAMC gauge improvements in user acceptance and familiarity with the SVI

Residency Applicants Prefer Online System for Scheduling Interviews

Introduction: Residency coordinators may be overwhelmed when scheduling residency interviews. Applicants often have to coordinate interviews with multiple programs at once, and relying on verbal or email confirmation may delay the process. Our objective was to determine applicant mean time to schedule and satisfaction using online scheduling. Methods: This pilot study is a retrospective analysis performed on a sample of applicants offered interviews at an urban county emergency medicine residency. Applicants were asked their estimated time to schedule with the online system compared to their average time using other methods. In addition, they were asked on a five-point anchored scale to rate their satisfaction. Results: Of 171 applicants, 121 completed the survey (70.8%). Applicants were scheduling an average of 13.3 interviews. Applicants reported scheduling interviews using the online system in mean of 46.2 minutes (median 10, range 1-1800) from the interview offer as compared with a mean of 320.2 minutes (median 60, range 3-2880) for other programs not using this system. This difference was statistically significant. In addition, applicants were more likely to rate their satisfaction using the online system as “satisfied” (83.5% vs 16.5%). Applicants were also more likely to state that they preferred scheduling their interviews using the online system rather than the way other programs scheduled interviews (74.2% vs 4.1%) and that the online system aided them coordinating travel arrangements (52.1% vs 4.1%). Conclusion: An online interview scheduling system is associated with higher satisfaction among applicants both in coordinating travel arrangements and in overall satisfaction. [West J Emerg Med. 2015;16(2):352-354.

The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year?

Introduction: There has been concern of increased emergency department (ED) length of stay (LOS) during the months when new residents are orienting to their roles. This so-called “July Effect” has long been thought to increase LOS, and potentially contribute to hospital overcrowding and increased waiting time for patients. The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents.Methods: We performed a retrospective analysis of a nationally representative sample of 283,621 ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2001 to 2008. We stratified the sample by proportion of visits seen by a resident, and compared July to the rest of the year, July to June, and July and August to the remainder of the year. We compared LOS for teaching hospitals to non-teaching hospitals. We used bivariate statistics, and multivariable regression modeling to adjust for covariates.Results: Our findings show that at teaching hospitals with residents, there is no significant difference in mean LOS for the month of July (275 minutes) versus the rest of the year (259 min), July and August versus the rest of the year, or July versus June. Non-teaching hospital control samples yielded similar results with no significant difference in LOS for the same time periods. There was a significant difference found in mean LOS at teaching hospitals (260 minutes) as compared to non-teaching hospitals (185 minutes) throughout the year (p<0.0001).Conclusion: Teaching hospitals with residents in the ED have slower throughput of patients, no matter what time of year. Thus, the “July Effect” does not appear to a factor in ED LOS. This has implications as overcrowding and patient boarding become more of a concern in our increasingly busy EDs. These results question the need for additional staffing early in the academic year. Teaching hospitals may already institute more robust staffing during this time, preventing any significant increase in LOS. Multiple factors contribute to long stays in the ED. While patients seen by residents stay longer in the ED, there is little variability throughout the academic year. [West J Emerg Med. 2014;15(1):88–93.

Change to an Informal Interview Dress Code Improves Residency Applicant Perceptions

Introduction: Residency interview apparel has traditionally been the dark business suit. We changed the interview dress code from a traditionally established unwritten ‘formal’ attire to an explicitly described ‘informal’ attire. We sought to assess if the change in dress code attire changed applicants’ perceptions of the residency program or decreased costs.Methods: The authors conducted an anonymous survey of applicants applying to one emergency medicine residency program during two application cycles ending in 2012 and 2013. Applicants were asked if the change in dress code affected their perception of the program, comfort level, overall costs and how it affected their rank lists.Results: We sent the survey to 308 interviewed applicants over two years. Of those, 236 applicants completed the survey for a combined response rate of 76.6% (236/308). Among respondents, 85.1% (200 of 235) stated they appreciated the change; 66.7% (154 of 231) stated the change caused them to worry more about what to wear. Males were more uncomfortable than females due to the lack of uniformity on the interview day (18.5% of males [25/135] vs. 7.4% of females [7/95], collapsed results p-value 0.008). A total of 27.7% (64/231) agreed that the costs were less overall. The change caused 50 of 230 (21.7%) applicants to rank the program higher on their rank list and only one applicant to rank the program lower.Conclusion: A change to a more informal dress code resulted in more comfort and fewer costs for applicants to a single residency program. The change also resulted in some applicants placing the program higher on their rank order list. [West J Emerg Med. 2015;16(1):-0.]